Method for inserting and deploying an expandable interbody spinal fusion implant

Abstract

Methods for inserting and expanding fusion implants having an expandable height are disclosed. An implant holder having a passage therethrough that is adapted to receive an expander driver is provided. The implant holder is attached to the implant, and the expander driver is inserted through the passage to engage an expander of the implant. Using the expander driver, the expander is rotated from a first position to a second position to expand the expandable implant from a first collapsed height to a second expanded height.

1. A method for expanding an expandable spinal implant having an upper portion, a tower portion, and an expander between the upper and lower portions adapted to increase the height of the implant, the method comprising:
 providing an implant holder having a passage therethrough adapted to receive an expander driver; 
 attaching the implant holder to the implant; 
 inserting the expander driver having a shaft through the passage of the implant holder to engage the expander of the implant; 
 rotating the expander driver to rotate the expander from a first position where a first set of contact surfaces of the expander engage the upper and lower portions to a second position to engage a second set of contact surfaces of the expander with the upper and lower portions and expand the expandable implant from a first collapsed height to a second expanded height; and 
 restraining movement of the expander and the first and second sets of contact surfaces of the expander, during rotation of the expander, along a longitudinal axis of the implant to maintain the expander in the same location along the longitudinal axis throughout rotation. 
 
     
     
       2. The method of  claim 1 , wherein the providing act includes the act of providing the implant holder having extensions having an exterior surface adapted to engage the implant, the extensions being adapted to move between a disengaged position with the extensions at a first distance from one another and an engaged position with the extensions at a second distance from one another, the second distance being larger than the first distance. 
     
     
       3. The method of  claim 2 , wherein the providing act includes the act of providing the implant holder with extensions having an interior surface oriented toward the passage of the implant holder, the extensions being adapted to move away from the longitudinal axis of the implant holder to the engaged position by an outward force applied to the interior surface. 
     
     
       4. The method of  claim 3 , wherein the attaching act includes the act of applying an outward force to the interior surface of the extensions to engage the extensions with the implant. 
     
     
       5. The method of  claim 3 , wherein the providing act includes the act of providing the implant holder having a shaft adapted to move along at least a portion of the length of the passage of the implant holder, the distal end of the shaft being sized and shaped to cooperatively engage the interior surface of the extensions of the implant holder to spread apart the extensions to lock the implant holder to the implant. 
     
     
       6. The method of  claim 2 , wherein the providing step includes the step of providing the implant holder with extensions adapted to be moved toward the longitudinal axis of the implant holder by an inward force applied to the exterior surface to permit the extensions to pass into the trailing end of the implant and to permit the extensions to engage the implant after the inward force is removed. 
     
     
       7. The method of  claim 6 , further comprising the step of applying an inward force to the exterior surface of the extensions to permit the extensions to pass into the trailing end of the implant. 
     
     
       8. The method of  claim 7 , wherein the attaching step includes the step of removing the inward force to the exterior surface of the extensions to permit the extensions to engage the implant. 
     
     
       9. The method of  claim 2 , wherein the providing step includes the step of providing the implant holder with extensions having at least one projection adapted to cooperatively engage at least a portion of the trailing end of the implant. 
     
     
       10. The method of  claim 1 , further comprising the step of performing the spinal implant surgery from a position posterior to the transverse processes of the vertebral bodies. 
     
     
       11. The method of  claim 1 , further comprising the step of performing the spinal implant surgery from a position anterior to the transverse processes of the vertebral bodies. 
     
     
       12. The method of  claim 1 , further comprising the acts of performing the procedure on both sides of the spinal midline of the spine and inserting two implants into the spine, each of the implants having a width less than half the width of the disc space. 
     
     
       13. The method of  claim 1 , further comprising the act of positioning into a disc space between adjacent vertebral bodies a guard having an extension for insertion into the disc space previously occupied by the disc and for bearing against end plates of adjacent vertebral bodies of the spine to generally restore the spacing of the disc space between the adjacent vertebral bodies. 
     
     
       14. The method of  claim 13 , further comprising the act of forming, through the guard, an implantation space across at least the height of the disc space. 
     
     
       15. The method of  claim 14 , further comprising the act of inserting the implant into the implantation space. 
     
     
       16. The method of  claim 15 , wherein the act of inserting the implant includes the act of using the implant holder to insert the implant into the implantation space through the guard. 
     
     
       17. The method of  claim 16 , further comprising the act of removing the implant holder from the guard after the act of using the implant holder to insert the implant. 
     
     
       18. The method of  claim 16 , further comprising the act of removing the implant holder and the guard together after the act of using the implant holder to insert the implant. 
     
     
       19. The method of  claim 15 , further comprising the act of removing the guard after the inserting act. 
     
     
       20. The method of  claim 14 , wherein the forming act includes the act of forming the implantation space with a bone removal instrument. 
     
     
       21. The method of  claim 20 , wherein the forming act includes the act of one of milling, drilling, reaming, chiseling, and trephining the implantation space. 
     
     
       22. The method of  claim 13 , wherein the positioning act includes the act of positioning a guard having multiple extensions for insertion into the disc space and for bearing against end plates of the two adjacent vertebrae. 
     
     
       23. The method of  claim 13 , wherein the positioning act includes the act of spacing the adjacent vertebrae apart. 
     
     
       24. The method of  claim 13 , wherein the positioning act includes the act of inducing angulation to the adjacent vertebrae relative to one another. 
     
     
       25. The method of  claim 21 , wherein the inducing angulation act includes the act of restoring lordosis to the spine. 
     
     
       26. The method of  claim 24 , wherein the inducing angulation act includes the act of restoring kyphosis to the spine. 
     
     
       27. The method of  claim 13 , wherein the positioning act includes the guard having upper and lower members adapted for movable engagement with one another. 
     
     
       28. The method of  claim 27 , wherein the positioning act includes the act of pivoting the upper and lower members of the guard to induce angulation of the adjacent vertebral bodies. 
     
     
       29. The method of  claim 13 , further comprising the act of engaging the guard into the adjacent vertebrae. 
     
     
       30. The method of  claim 1 , further comprising the act of inserting a spinal distractor into a disc space between adjacent vertebral bodies to provide for proper spacing of the disc space between the vertebral bodies. 
     
     
       31. The method of  claim 30 , wherein the act of inserting a spinal distractor includes the act of inducing angulation to the adjacent vertebrae. 
     
     
       32. The method of  claim 30 , further comprising the act of removing the spinal distractor prior to forming an implantation space. 
     
     
       33. The method of  claim 1 , further comprising the act of inserting the implant into an implantation space. 
     
     
       34. The method of  claim 33 , wherein the act of inserting includes the act of screwing the implant into the implantation space. 
     
     
       35. The method of  claim 33 , wherein the step of inserting includes the step of pushing the implant into the implantation space. 
     
     
       36. The method of  claim 33 , wherein the step of inserting the implant includes the step of driving the implant into the implantation space with the implant holder. 
     
     
       37. The method of  claim 33 , wherein the step of inserting the implant includes the step of removing the implant from the implantation space with the implant holder. 
     
     
       38. The method of  claim 33 , further comprising the act of removing the implant holder from the implant after the act of inserting the implant. 
     
     
       39. The method of  claim 33 , wherein the inserting act includes inserting an implant comprising a fusion promoting substance. 
     
     
       40. The method of  claim 33 , wherein the inserting act includes inserting an implant comprising a bone ingrowth surface. 
     
     
       41. The method of  claim 33 , wherein the inserting act includes inserting a spinal implant that is a spinal fusion implant for promoting fusion between adjacent vertebral bodies, the implant having upper and lower surfaces for placement between and in contact with the adjacent vertebral bodies, each of the upper and lower surfaces having at least one opening adapted to permit bone from the adjacent vertebral bodies to grow through the implant. 
     
     
       42. The method of  claim 41 , wherein the inserting act includes inserting a spinal fusion implant having a hollow between the upper and lower surfaces for holding fusion promoting substances. 
     
     
       43. The method of  claim 33 , wherein the inserting act includes inserting a spinal fusion implant that is separable into an upper member and a lower member to permit the placement of the expander between the upper and lower members. 
     
     
       44. The method of  claim 43 , wherein the inserting act includes inserting a spinal fusion implant with the upper and lower members being at least in part arcuate. 
     
     
       45. The method of  claim 44 , wherein the inserting act includes screwing a threaded spinal fusion implant into an implantation space in the spine. 
     
     
       46. The method of  claim 33 , wherein the inserting act includes inserting a spinal fusion implant configured for at least in part linear insertion into a prepared implantation space between the adjacent vertebral bodies. 
     
     
       47. The method of  claim 33 , wherein the inserting act includes inserting a spinal fusion implant having surface projections configured to resist expulsion of the implant from an implantation space into which the implant is adapted to be inserted. 
     
     
       48. The method of  claim 33 , wherein the inserting act includes the act of inserting an implant having a hollow between the ends that is generally unobstructed by an expander so as to allow for the unimpeded loading of the interior of the implant with a fusion promoting substance. 
     
     
       49. The method of  claim 33 , wherein the inserting act includes the act of inserting an implant having a trailing end adapted to be engaged to the implant holder. 
     
     
       50. The method of  claim 33 , wherein the inserting act includes the act of inserting an implant comprised at least in part of one of bone and bone growth promoting material. 
     
     
       51. The method of  claim 33 , wherein the inserting step includes the step of inserting an implant that is an inert spacer. 
     
     
       52. The method of  claim 33 , wherein the inserting step includes the step of inserting an implant that is an artificial disc. 
     
     
       53. The method of  claim 33 , wherein the inserting step includes the step of inserting an implant that is a bone graft. 
     
     
       54. The method of  claim 1 , further comprising the step of loading the implant with fusion promoting substance. 
     
     
       55. The method of  claim 54 , wherein the step of loading includes the step of compressively loading the implant with fusion promoting substance. 
     
     
       56. The method of  claim 54 , wherein the step of compressively loading includes pressing the fusion promoting substance into the implant with one of a tamp, press, and piston. 
     
     
       57. The method of  claim 54 , further comprising the step of inserting the implant into the spine, wherein at least a portion of the loading step occurs after the step of inserting the implant. 
     
     
       58. The method of  claim 54 , wherein the loading step includes loading the implant with the fusion promoting substance being selected from one of bone, bone derived products, demineralized bone matrix, ossifying proteins bone morphogenetic protein, hydroxyapatite, and genes coding for the production of bone. 
     
     
       59. The method of  claim 54 , further comprising the step of retaining the fusion promoting substance within the implant after the step of loading. 
     
     
       60. The method of  claim 59 , wherein the step of retaining includes the step of attaching a cap to the implant to retain the fusion promoting substance. 
     
     
       61. The method of  claim 1 , further comprising the act of treating the implant with a fusion promoting substance. 
     
     
       62. The method of  claim 1 , wherein the implant is in combination with a chemical substance adapted to inhibit scar formation. 
     
     
       63. The method of  claim 1 , wherein the implant is in combination with an antimicrobial material. 
     
     
       64. The method of  claim 1 , wherein the act of inserting the expander driver includes the act of assembling the implant, implant holder, and expander driver together so that the expander driver is in a first locked position relative to the implant holder to prevent rotation of the expander driver relative to the implant holder. 
     
     
       65. The method of  claim 64 , further comprising the act of partially retracting the expander driver to a second locked position that permits rotation of the expander driver relative to the implant holder so as to allow the expander driver to rotate the expander of the implant. 
     
     
       66. The method of  claim 65 , further comprising the act of removing the expander driver from the implant and the implant holder. 
     
     
       67. The method of  claim 1  ,further comprising the act of limiting the depth of penetration of the expander driver into and through the expander of the implant. 
     
     
       68. The method of  claim 1 , further comprising the act of removing the expander driver from the implant and the implant holder. 
     
     
       69. The method of  claim 1 , further comprising the act of passing fusion promoting substance Through the passage of the implant holder and into the implant. 
     
     
       70. The method of  claim 69 , further comprising the act of using the expander driver to move the fusion promoting substance through the passage of the implant holder and into the interior of the implant. 
     
     
       71. The method of  claim 70 , further comprising the act of advancing the expander driver through the fusion promoting substance in the implant until the expander driver reaches and is advanced into engagement with the expander of the implant. 
     
     
       72. The method of  claim 1 , wherein the act of rotating the expander driver includes the act of expanding the leading end of the implant to increase the maximum implant height which is proximate the leading end of the implant. 
     
     
       73. The method of  claim 1 , wherein the act of rotating the expander driver includes the act of expanding the trailing end of the implant to increase the maximum implant height which is proximate the trailing end of the implant. 
     
     
       74. The method of  claim 1 , wherein the act of rotating the expander driver includes the act of expanding bath the leading end and the trailing end of the implant to increase the maximum implant height proximate both the leading end and the trailing end of the implant. 
     
     
       75. The method of  claim 1 , wherein the act of rotating the expander driver includes the act of expanding the implant to induce angulation to the adjacent vertebral bodies. 
     
     
       76. The method of  claim 1 , wherein the attaching act includes the act of locking the implant holder to the implant. 
     
     
       77. The method of  claim 76 , further comprising the act of unlocking the implant holder from the implant. 
     
     
       78. The method of  claim 77 , further comprising the act of removing the implant holder from the implant. 
     
     
       79. A method for expanding an expandable implant having an upper portion, a lower portion, and an expander between the upper and lower portions adapted to increase the height of the implant, the method comprising:
 providing an implant holder having a passage therethrough adapted to receive an expander driver; 
 attaching the implant holder to the implant; 
 inserting the expander driver having a shaft through the passage of the implant holder to engage the expander of the implant; 
 rotating the expander driver to rotate the expander in a plane generally perpendicular to a longitudinal axis of the implant from a first position with a first set of contact surfaces of the expander engaging the upper and lower portions to a second position to engage a second set of contact surfaces of the expander with the upper and lower portions, and simultaneously expanding the expandable implant from a first collapsed height to a second expanded height; and 
 maintaining the expander, during rotation thereof, in a fixed position along the longitudinal axis of the implant so that the expander does not move along the longitudinal axis.